3 Increasing Medication Compliance in the Depressed Patient Collaboration / Coordination According to the CDC, approximately 8% of Americans report current depression and nearly 20% of adults are affected by some kind of major depressive disorder at least once in their lifetime. Studies have shown that a majority of these patients will initiate care with their primary care physician rather than a mental health professional. Therefore, it is clear that effective collaboration between the PCP and the behavioral health provider is critical in the successful treatment of depression. What effective treatment can achieve: Pharmacotherapy has been shown to be a critical part of the effective treatment of patients with depression. Coupled with appropriate forms of psychological therapy, most patients experience good outcomes with appropriate antidepressants taken for the proper duration. The most common treatments include antidepressant medication, psychotherapy or a combination of the two. Patients need to be monitored very carefully during the acute phase (the first three months) and the initial continuation phase (the first six months) of treatment, so the clinician can adjust the dosage or type of medication, if necessary. The risk of depression is higher in patients with serious medical co-morbidities and treatment of depression may have a beneficial effect on their overall functioning and recovery. About 2/3 of those who suffer from major depression can achieve full remission. Medical Compliance: Medication Compliance is a major component of a successful therapeutic outcome. Recent studies show that 42% of patients taking an anti-depressant will become non-compliant with medication within the first 30 days, while a total of 72% of patients will become non-compliant before the 90th day. Source: Magellan Early treatment is more effective and helps prevent the likelihood of serious recurrences.

4 Increasing Medication Compliance in the Depressed Patient (cont.) According to the American Psychiatric Association (APA) Practice Guidelines for the Treatment of Patients with Major Depressive Disorders: Factors to consider when choosing medication include: Anticipated side effects Safety/tolerability History of prior response Cost Potential drug interactions Patient preference Co-occurring psychiatric and medical conditions Patience is important. Improvement with pharmacotherapy may not be seen until after four to eight weeks of treatment. If there is not at least moderate improvement by eight weeks, then a reappraisal of the treatment regimen should be conducted. The goals of the acute phase. These include inducing a remission of symptoms and a resumption of baseline functional status. Continuation Phase. Patients should be kept on treatment at the same dose, intensity, and frequency as in the acute phase for 16 to 20 weeks following remission to prevent relapse. Maintenance Phase. In order to prevent relapse, the treatment that was effective in the acute and continuation phases should be used for: 6-12 months for the first depressive episode 3 years for the second episode indefinitely for a second episode with complicating factors (or a third episode) Psychiatrist referrals may be in order. Refer treatment resistant patients to a psychiatrist. Source: Magellan 2

5 Antidepressant medication management. Factors to be considered should include: The patient. Their perceptions and understanding of their depression and medications (taking into account the patient s culture, socioeconomic status and health literacy). The medication. How complicated it will be for the patient to manage, the side effects and the cost The Provider. Primary care physician vs. behavioral health specialist, knowledge of psychopharmacology and psychotherapy. Disease Burden. Chronic vs. acute, co-morbid medical problems, substance abuse. Understanding. Lack of patient understanding of the proper use of antidepressant medications and the importance of staying on therapy. Communication and coordination. A lack of communication and coordination of treatment between providers. Improved Treatment Adherence. Providers can help to improve treatment adherence through the following: A strong alliance. Establishment of a strong alliance with the patient Patient education. Educate patients about their illness, medications and adherence with their treatment. Compliance sssistance. Providing medication compliance assistance, such as pillboxes Patient follow-ups. Be sure to schedule patient follow-ups. Behavioral health specialist. Incorporate behavioral health specialists when appropriate. Tip sheet. Provide a patient tip sheet (available from Health Partners Plans. Source: Magellan Access. Efficient patient access to obtain prescriptions. Affordable prescriptions. Patient follow-up. 3

7 Resources for Prescription Drug Assistance Programs: One reason that patients may not take their medications is the inability to pay for them. The following information has been provided by our Health Partner Plans Behavioral Health Provider, Magellan Health Services. It provides resources to assist patients in paying for their medication. Each website can help locate programs that offer information about discounted or free medication. The application process may differ from program to program. Some may require the patient to apply and some may require that you apply for them. This list serves as a resource for you, your office and your patient. Pennsylvania Prescription Drug Assistance Programs This website provides a list of assistance programs for Pennsylvania residents. This provides access to multiple programs giving details as to how to access the individual programs. Partnerships for Prescription Assistance This assistance program joins pharmaceutical companies, doctors, other health care providers, patient advocacy organizations, and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that is right for them. This site offers a single point of access to more than 475 programs that offer assistance, including the pharmaceutical companies themselves. https://www.pparx.org/intro.php Needy Meds This is a website that offers a direct connection with pharmaceutical companies who offer assistance. The website directs you to choose the medication by name, and it will take you to the company that produces that medication. You will need to have the name of the medication to use this site. Free Medication Revolution Assists with free or low cost medication Programs for Specific Medications There are programs available for specific medications for those patients that have insurance but still have difficulty with the co-payment. These programs are generally offered through large pharmacy chains and larger grocery store chains. Wal-Mart Wal-Mart s program offers a 30-day supply for a $4.00 co-pay and $10.00 co-pay for a 90-day supply. Only specific generic medications are included in this program. Source: Magellan 5

MOLINA HEALTHCARE OF CALIFORNIA MAJOR DEPRESSION IN ADULTS IN PRIMARY CARE HEALTH CARE GUIDELINE (ICSI) Health Care Guideline Twelfth Edition May 2009. The guideline was reviewed and adopted by the Molina

These Guidelines are based in part on the following: American Academy of Child and Adolescent Psychiatry s Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder,

American Society of Addiction Medicine Public Policy Statement on Treatment for Alcohol and Other Drug Addiction 1 I. General Definitions of Addiction Treatment Addiction Treatment is the use of any planned,

Photos placed in horizontal position with even amount of white space between photos and header Photos placed in horizontal position with even amount of white space between photos and header Worksite Depression

Guidelines for the Use of Controlled Substances in the Treatment of Pain Adopted by the New Hampshire Medical Society, July 1998 Section I: Preamble The New Hampshire Medical Society believes that principles

Screening Tools and Interventions for Common Behavioral Health Disorders TXPEC-0772-13 Screening Tools and Interventions for Common Behavioral Health Disorders Depression Depression is a potentially life-threatening

Day Treatment Mental Health Adult Definition Day Treatment provides a community based, coordinated set of individualized treatment services to individuals with psychiatric disorders who are not able to

It's all about employees; always has been, always will be. Improving the Value of an EAP Through a Coordinated Drug Intervention Presenters: Fred Newman Mike Hoffman What the Media are Reporting A significant

Lessons on the Integration of Medicine and Psychiatry Edward Post, MD, PhD Associate Professor of Internal Medicine, University of Michigan VA Health Services Research & Development Center of Excellence,

LEVEL III.5 SA: SHT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE) Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance-Related Disorders

Management of moderate to severe ere (including psychotic) depression in children and young people tiers 2 4 bring together all NICE guidance, quality standards and other NICE information on a specific

Partial Hospitalization - MH - Adult (Managed Medicaid only Service) Definition Partial hospitalization is a nonresidential treatment program that is hospital-based. The program provides diagnostic and

LEVEL II.1 SA: INTENSIVE OUTPATIENT - Adult Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance- Related Disorders of the American Society

CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare and Your Mental Health Benefits This is the official government booklet about Medicare mental health benefits for people in the Original Medicare Plan.

Performance Standards Co-Occurring Disorder Competency Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best

D. Main Section of the proposal The purpose of this project is to improve health outcomes for treatment of tobacco dependence among the Arizona behavioral health population. This will be accomplished through

LEVEL I SA: OUTPATIENT INDIVIDUAL THERAPY - Adult Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance-Related Disorders of the American

4.40 STRUCTURED DAY TREATMENT SERVICES 4.401 Substance Use Partial Hospitalization Program (Adults and Adolescents) Description of Services: Substance use partial hospitalization is a nonresidential treatment

BACKGROUND More than 25% of people with diabetes take insulin ADA and the European Association recently issued a consensus algorithm for management of type 2 diabetes Insulin identified as the most effective

THE OFFICE OF SUBSTANCE ABUSE SERVICES REQUIREMENTS FOR THE PROVISION OF RESIDENTIAL DETOXIFICATION SERVICES BY PROVIDERS FUNDED WITH DBHDS RESOURCES PURPOSE: The goal of this document is to describe the

Treatment of Chronic Pain: Our Approach Today s webinar was coordinated by the National Association of Community Health Centers, a partner with the SAMHSA-HRSA Center for Integrated Health Solutions SAMHSA

Security Health Plan provides coverage of various mental health/aoda (alcohol and other drug abuse) benefits to individual and employer group members. These benefits are managed by Security Health Plan.

Management of depression in young people in primary care Key recommendations: 1 Management A young person with mild or moderate depression should typically be managed within primary care services A strength-based

CENTERS FOR MEDICARE & MEDICAID SERVICES Medicare & Your Mental Health Benefits This official government booklet has information about mental health benefits for people with Original Medicare, including:

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT OF ALCOHOL MISUSE Date: March 2015 1 1. Introduction Alcohol misuse is a major public health problem in Camden with high rates of hospital

Keep Your Mind and Body Healthy: Understanding Mental Health Providers, Care and Coverage Our mental health is a vital part of our overall well-being. It affects how we think, how we feel, and how we act.

Using antidepressants in children and young people bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They

Addiction Psychiatry Program Site Specific Goals and Objectives Addiction Psychiatry (ADTU) Goal: By the end of the rotation fellow will acquire the knowledge, skills and attitudes required to recognize

Understanding Prescription Assistance Programs (PAPs) The use of prescription medicines has become an increasingly important part of quality medical care. Two out of every three visits to the doctor end

Fixing Mental Health Care in America A National Call for Measurement Based Care in Behavioral Health and Primary Care An Issue Brief Released by The Kennedy Forum Prepared by: John Fortney PhD, Rebecca

18 Behavioral Health Services INTRODUCTION The State of Arizona has contracted the administration of the AHCCCS mental health and substance abuse services program to the Arizona Department of Health Services

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Mental Health Services ICN 903195 January 2015 This booklet was current at the time it was published or uploaded onto the

1 DEPRESSION CARE PROCESS STEP EXPECTATIONS RATIONALE ASSESSMENT/PROBLEM RECOGNITION 1. Did the staff and physician seek and document risk factors for depression and any history of depression? 2. Did staff

Depression Screening in Primary Care Toni Johnson, MD Kristen Palcisco, BA, MSN, APRN MetroHealth System Our Vision Make Greater Cleveland a healthier place to live and a better place to do business. 2

Integrating Primary Care and Behavioral Health Services: A Compass and A Horizon A curriculum for community health centers Developed for the Bureau of Primary Health Care Managed Care Technical Assistance

Illinois Insurance Facts Illinois Department of Insurance Mental Health and Substance Use Disorder Coverage Revised October 2012 Note: This information was developed to provide consumers with general information

Update on guidelines on biological treatment of depressive disorder Dr. Henry CHEUNG Psychiatrist in private practice 2013 update International Task Force of World Federation of Societies of Biological

CARE MANAGEMENT FOR LATE LIFE DEPRESSION IN URBAN CHINESE PRIMARY CARE CLINICS Dept of Public Health Sciences February 6, 2015 Yeates Conwell, MD Dept of Psychiatry, University of Rochester Shulin Chen,

how to choose the health plan that s right for you It s easy to feel a little confused about where to start when choosing a health plan. Some people ask their friends, family, or co-workers for advice.

TM Understanding Depression The Road to Feeling Better Helping Yourself Your Treatment Options A Note for Family Members Understanding Depression Depression is a biological illness. It affects more than

Performance Standards Non-Hospital Rehabilitation Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best practice

CHAPTER He-W 500 MEDICAL ASSISTANCE PART He-W 513 SUBSTANCE USE DISORDER (SUD) TREATMENT AND RECOVERY SUPPORT SERVICES He-W 513.01 Purpose. The purpose of this part is to establish the procedures and requirements

Gainful Employment Information The Field of Counseling Job Outlook Veterans Administration one of the most honorable places to practice counseling is with the VA. Over recent years, the Veteran s Administration